Not really worth it for significant scarring - Santa Monica, CA

I just had Total FX, two days ago on July 22, 2008...

I just had Total FX, two days ago on July 22, 2008 in Santa Monica, CA. She is the dermatologist seen on the show "Extreme Makeover", but it was actually one of her nurses that performed the procedure for acne scarring and a few small undereye wrinkles.

I am a 41 year old female with significant rolling scars (depressed scars)on my forehead and cheeks. I have had 3 past Fraxel treatments last year that did not lead to noticeable improvement, and that cost me $900 per treatment performed by a different doctor's office in Los Angeles.

The nurse did 3 passes of Deep FX to my forehead and cheeks using a setting of 17.5 which she said was the highest she was told she could go, at a training session she had. I believe the Deep FX machine goes up to 20 or 21, however. Most people get 2 passes, not 3.

I did not feel pain because I had taken 1 valium and 2 vicodin in her office prior to the appt, and also had put quite alot of EMLA numbing creme all over my face one hour prior to the procedure. I smelled burning skin during the procedure.

When it was time to do the Active FX directly after the Deep FX, this was performed all over my face at a setting of 100. I am not sure what that means or how high that is but I think it is a moderate setting as I do not have skin issues on the other parts of my face. The nurse used the Active FX in the undereye area for fine wrinkles that I have there since she did not treat this area during Deep FX which would have probably caused damage rather than good, since Deep FX is better for scarring.

The Active FX actually hurt a bit so I was trying to control my fidgeting hands as I did not want to affect her treatment or cause her to lower her settings. I just wanted to do this once as I am so tired of getting laser treatments for my skin (I have also in the past, had 4 CoolTouch laser treatments, 2 C02 treatments for scarring, and 1 full face dermabrasion 13 years ago...all of this helped with the scarring but it was still quite visible. Following those past laser treatments I had 13 separate silicon injection appts using micro droplets of FDA approved silicone which actually is not approved for scar injection but there are doctors out there who will do it if you are willing to sign a ton of waivers. The best doctor in the country for silicone is {edited - you must contact this user privately by clicking on their username to receive this information}, in NYC who is a pioneer, along with {edited - you must contact this user privately by clicking on their username to receive this information} of NYC who used to perform silicone injections but no longer does.). I have also used a doctor in Torrance, CA for silicone who is amazing and half the price of {edited} in NY. This has drastically filled in more severely depressed scars but my skin still looks very scarred, thus the laser resurfacing treatments I endure.

Anyway--back to my Total FX review...I am now on my second day of healing. The procedure was done two days ago and on the first day and night there was siginificant oozing and dripping of orangey looking, sticky fluid..I think it was plasma (clear blood). I slept propped up with towels on my pillow and used a giant towel as a blanket near my face because the oozing was so extreme. There were alot of blood spots all over my cheeks from the Deep FX, and swelling but no pain. It looked like my skin had been ripped off..similar to C02.I keep Aquaphor on my skin and yesterday washed my face 3 times and reapplied the Aquaphor. I am on prescribed steroids to help with the swelling, and also on Cipro to fight possible infection.

Since it's 2 days since my procedure, I am still washing 3 times a day and smearing thick layers of Aquaphor on my face. The oozing has stopped and the swelling is starting to barely go down. My entire face is scabbed and crusted, and it's starting to turn brown. It won't peel for another couple of days.

I am not working right now, so I have plenty of time to allow for healing and not wearing makeup. I really think you need atleast a full week of not going anywhere, even outside at all, to do a good Deep FX/Active FX combination, as I never would do this if I was working unless I was on a full week vacation.

I will write again in a day or two and probably post pics of my before and after, as well as my day to day healing.

Updated on Jul 24, 2008:

Here are new pics 2 days after my Total FX procedure. I had Deep FX to my forehead and both cheeks at 3 passes each, on a 17.5 setting. I was told that 20 or 21 were the highest settings the laser would go for Deep FX and that the doctor did not think it was safe to do any patients at anything above 17.5 which is what I received. I am still waiting to see the final results, and know that scars usually show up again post healing at about 2-3 weeks post op. I am sure once the scabby, crusting parts fall off and the swelling goes down some, my skin will look flawless but that's only due to swelling and there will be some scars showing up again within 2 weeks, with the final result at about 3 months post op. I was extremely disappointed with Fraxel, which I had 3 times last year for these scars and it did nothing, but empty my wallet of almost $3000 for 3 treatments. I am very skeptical about the laser hype for scars, so we will see what this does for me.

Updated on Jul 25, 2008:

I am on the 3rd day post Total FX treatment. The oozing and bleeding have stopped, and the itching and peeling of dead brown skin has begun. I still keep Aquaphor smeared all over my face and am taking steroids for anti inflammatory issues, as prescribed by my doctor. The areas where the Deep FX was performed are taking longer to heal, and the areas that were only treated with Active FX (undereye, chin, nose and lip area) have alot of peeling 50% complete, with new pink skin showing underneath. I am still very swollen. There are still bloody scabs and crusting in the Deep FX areas of my cheeks. It is too early to know if there is any significant improvement in scarring.

Updated on Jul 28, 2008:

These are photos taken post-Total FX treatment which was 6 days ago. I have already posted photos of what I looked like, prior to the laser treatment, and also what I looked like one day after the treatment. Now I am showing what I look like today, on the 6th day. All of the scabbing fell off on its own during regular washings, by the end of the 4th day following my treatment. I now have red skin, that is shiny and smooth. My biggest issue in why I wanted to get this treatment was for depressed, rolling scars which Deep FX is supposed to treat, and for fine lines under my eyes that Botox cannot treat, so I hoped Active FX would treat this. I can see the fine lines under my eyes are ALL gone, 100% which is a surprise.

It's too early to know if all of my swelling has gone down yet , because from what I can see, about 90% of my rolling scars to cheeks and forehead are GONE. I do, however, still have the same enlarged pore/icepick type scars I had prior to the procedure, and I am not sure that Deep FX really helped with this at all. This does not bother me, however, because I really cared much more about getting rid of the depressed scars which were really prominent. I would say this procedure took 5 years off of my face (I am 41, so I still have issues with slight drooping to my skin below the cheekbone which you can see in one of my pics.).

I go back to the doctor's office tomorrow for a follow up exam so that they can see how I healed. I am really hoping that my success is not an illusion because I know based upon experience getting 3 past Fraxel treatments, what I thought looked like a great result in diminishing scars actually was a premature opinion since over the following 2 weeks I noticed the scars returned, and it was just swelling that made me think the Fraxel had worked. I hope with Total FX, that is not the case. I will write again and show more pics if I see the scars have returned, but I believe they will not..the Deep FX seems to be very impressive for a change considering alot of lasers promise improvement and then don't deliver.

Updated on Aug 4, 2008:

OK, so it is now 2 weeks post Total FX. I am posting new pics of my healing. The swelling appears to have gone down quite a bit, when I thought there was no more, and many of the rolling scars on my LEFT cheek have returned. The scars on the RIGHT side of my face, as well as my forehead, are not as bad as they were. There has been no change with the enlarged pore/icepick type of scars, so I will have to use a silicon filler type of primer makeup that fills in the pores that I have been using before Total FX(Smashbox cosmetics makes a great one called Photo Finish). I dont think there is a laser procedure out there that will erase icepick scars in one visit..even CO2 can't do that. If you want to reduce those types of scars, figure the laser takes off layers of skin so the pore actually appears BIGGER as it gets down to the lowest center of the scar..sort of like shaving top layers off a crater. You'd have to do it so many times to the surrounding area, so the best I could hope for is to soften them up. I did notice that once of the icepick scars on the left side of my face became LARGER and very noticeable after Total FX. I think because the top layers of the scar were removed by the Deep FX laser, and it opened up the scar more. A filler such as Juvaderm would probably do the trick to minimize it, so I will try that soon.

I did suspect that the rolling scars on my right cheek would heal better and be less noticeable that my left cheek once I had the procedure and was healing, because just after the procedure it was alot more bloody and scabby than the rest of my face. I guess the more skin that is taken off, the better my scar reduction. I wish the nurse had been even more invasive than 3 passes at 17.5 with Deep FX..maybe 5 passes?

I may do this procedure again next year when I take vacation time of a week off...but if you have young children, BE WARNED..the way you look for about 4 days after the procedure is so horrific, you might traumatize them. I would suggest doing it when they are extremely young, or having your significant other watch your children for the first few days. You will feel capable of taking care of them without pain, but you will look like your face has been burned off, to a bright red then brown state for awhile.

Updated on Aug 14, 2008:

3 1/2 weeks post treatment....rolling scars approximately 80%-90% GONE. No improvement to icepick scars yet. Forehead and right cheek are FAR smoother than prior to Total FX but some scars are visible but very faint. Left cheek still in need of treatment..perhaps Deep FX once more next year. Hyperpigmentation in Deep FX areas has appeared in a spotty pattern from cheeks to temple spite of wearing SPF 30 everyday. I do go out in the sun for about 20 mins a day with sunscreen and a big hat covering my skin, but the pigmentation has appeared, regardless. I have Mediterranean olive skin coloring so, like Asian or H/ispanic skin, am more prone to pigmenting. I may trat this with IPL laser treatments to fade the spots or I may just wait 6 months to see if they fade on their own. In my experience with this kind of pigmenting, they do not fade very well and hydroquinone bleaching does absolutely nothing for me. I will probably treat with a few IPL treatments. It was worth the tradeoff..atleast many of the rolling scars are completely gone.

Updated on Nov 23, 2008:

It's November 23, 2008 and I would consider my healing to be complete. Scroll down for new pics and results below. My feeling about Deep FX is now mixed due to the final result. They say it gets better over time but I did not experience this and in fact I think my scars returned over time, especially the rolling scars on my cheeks and forehead. Sometimes laser treatments do not erase scars but instead, just REARRANGE them to or RESHAPE them on your skin.

Take a look at the pics and you be the judge. I also left a comment below at the end of this blog in response to all of the people writing me.

Updated on Nov 27, 2008:

Just take a look at the very first before pics and then look at the final result. Everything else in between is irrelevant since the shadows and dimpling returned. It looked as though my skin and really improved from the procedure but it really did not do that much. I think if I do fillers in CONJUNCTION with the Deep FX I HAVE noticed that the end result is better than it used to be in just getting fillers and NO Deep FX in that A) the derm doc ony needs to use one syringe of Juvaderm now whereas prior to Deep FX he needed to use 2 syringes so right there I do ultimately save about $1000 per year on fillers. Well, take a look at the pics and decide for yourself.

I did not do Fraxel re: pair because I have already had regular Fraxel three times and did not get a result at all from it.

My only negative comment about Dr. Shamban would...

My only negative comment about Dr. Shamban would be after care follow up, when 80-90% of my scars returned within 6 months. When I contacted the office to have a follow up consultation and emailed current skin photos showing the returning scars, a nurse called and left a voicemail saying Dr. Shamban wanted me to come in and show her how the improvement I received on my $3000 Active /Deep FX was minimal after 6 months. I called back and asked the nurse if I was going to be steered to another expensive procedure because I wasn't prepared to pay for more work. She said she'd
find out and would let me know but I never heard back. I tried calling once more but they just never called again.

Santa Monica Dermatologic Surgeon

Ava Shamban offers numerous laser procedures at her Santa Monica facility. The staff is very courteous and sympathetic to each patient's concerns and they will provide you with the most advanced treatments that are available, rather than pushing an outdated laser treatment on you in order to pay their out of pocket costs on buying a laser machine a couple of years ago that is no longer considered viable.

3 out of 5 stars Overall rating
4 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
3 out of 5 stars Wait times
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Comments (31)

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I can't see of any pics that you had posted !!! how are your skin as of today?? Can you update with some more pics?
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yes i will post a pic. you can see how my neck is so much lighter than my face. not being able to use the lightening compounds from the dermatologist with my now sensitive skin means brown spot melasma hell!
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That's suck! The scar don't bother me as much as the hyperpigmention , some time we traded one problem for another one, it's just not worth it !
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I had Deep FX twice. no problems the first time. that is why I went in the for the second time 2 years later. I wanted smoother skin, but the real reason was to get rid of melasma. The doctor told me to use a different post op gel to put on the raw, open skin. i ended up having an allergic reaction and the nurses were too busy preparing for a 3 day holiday weekend to bother really deal with my complaints of discomfort and extremem itching. I found out later that allergic reactions at this stage are common . i kept applying for another 48 hours causing a GIANT ALLERGIC REACTION. I finally in a pain killer induced blur figured out I was having an allergic reaction. the nurses didnt'! so unfortunately I ended up with post inflammatory hyperpigmentation ( PIH) . and after such a GIANT ALLERGIC REACTION, my skin which was NEVER sensitive before , became sensitive to use any good bleaching creams , so now I have more melasma than ever. I was most upset that my doctor ( down in La Jolla) seem to back her nurses bad behavior. bottom line, stick with the IPL and skip the Deep FX. too risky
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this was a very thorough and sincere review. I have same issue (icepick scarring). I saw a recent procedure where the doctor sticks a needle and jabs at the underskin for patients like us. I did not catch the name of the procedure...but i think its something worth looking into....seems like you been through a lot and with minimal to no change...if you find out what it is...let us know...and I will also share if I find it myself...
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i had the same "no call back after complaining " service after a laser tx from a nurse at Shamban. seems to be the way they run their business.
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Is it safe to treat a scar that had 2 silicone microdroplets with Deep FX three months after the injection? I have seen reports of flashes etc. Is this true or are the treatments compatible? Thanks
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I heard that Fraxel repair is better than Deep FX. It goes deeper and stimulates more collagen. You said you did fraxel restore 3 times but that is weaker than Deep fx and you would need at least 5 treatments to see improvements in acne scars. I think you shuld look into fraxel repair and it will give you the best results.
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needling is the same concept of fraxel..If you go to ASLMS site you can see studies they are now using it in combination with fractionated.. It is much less dangerous than any laser because the possibility of thermal damage is elimenated... And I agree with you CO2 and some fractionated do use the same wavelength but in very different ways at different depths.. Best wishes in your quest..Thank you for shaing your experience..
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Geez You have been thru the ringer..My heart goes out to you.. You do a good job with make up and have a beautiful face high cheekbones ect How long ago did you try the fat grafting?? It has come a long way in the last two years and it's very technique dependent as to if the fat lasts or not.. Micro fat grafting with concentrated stem cells is just starting to be used in the U.S...Check it out they first started in France Fat can't be sucked out and reinjected.. Techniques have changed drasticly in the last year..And blood supply needs to be established so the are injecting less and closer to the muscle so this can happen,,, It may be worth looking into... As it's less expensive then a laser treatment and the risk of scarring is taken out of play... Maybe isolagen or vavleta Also clinicial lists all the new treatments being tested and it's free to participate.. If you researched exstensivly It may be worth browsing.. I saw many studies for fractionated and they are usualy done by people with the most experience...And Free because they need good study results to sell docs the lasers..I did see one study for multiple sessions 3 for acne scaring that is recruiting...
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Skingirl You should look into fat grafting and good ole ablative CO2 I would bet the farm you will see an unbelievable improvement compared to the other things you are doing... Fat has stem cells that affect your skin from below Researchers at UVA studied this treating injured vets who required skin grafting from burns and other injuries....Yours are damaged from the scarring and limit or keep producing disorganized or subpar collagen.. You are an ideal candidate for CO2 ablative with your light skin....Aside from downtime evry doctor will tell you it's the most effective treatment..The most common problem associated is a lightning of the treated area...But I've seen it make even severe acne scars as smooth as a babys bum... Also with the ice pick scars I’ve read a lot about needling..several studies have confirmed it works.. I’m not a doctor but I personally did this with an ice pick scar fraxel left me with as opposed to subcision and it has filled out and closed over the last month or so Buy a box of lancets from the drugstore take one of the ice pick scars cleanse it and puncture it 10-15 times to break up the tissue bands and follow with TNS recovery serum.. If it works for you then the needling would help since you have ice pick scars..You can order a derma roller online get the 1.5 mm or 2mm..The TNS recovery serum is important because it has growth factors in it.. I lightly steam my face after application and rubb in again..It’s not cheap and you want to get the best possible absorption… To make it convenient I purchased an hot pot used to boil water for tea around $15 and plugged it in my bathroom heats up in less than a min I don’t use a towel but put my face over it for 30 seconds and massage it in again..wait and follow with moisture.. This is the model I use Rival 4071-WN 32-Ounce Hot Pot Express You have my best wishes... Hope this can help in some way
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Hi, I've already had CO2 done derm doc did a skin test to see if a third time was possible but the test scarred my face and indicated I shouldn't have more CO2. Also, Deep FX IS CO2 made by the same manufacturers of the original ols school CO2 laser of the 1990's but now it's an advanced fractional laser that is non ablative. I tried fat grafting. The fat reabsorbed into my skin within a few months. I won't try needling. I am familiar with it but as I have spent atleast $50K on my skin repair at this point from age 16 on, I don't want to create the risk of more scars.
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No, I don't think so. The fillers have since gone and I haven't replaced them. I really don't think the end result was going to be a radical improvement from any improvement I had within the first month following the procedure. As it stands now, Dr. S saw my disappointing final result photos this week and wants me to go to her office so that she can see in person. Not sure why because her office requested the appt by calling me out of the blue. I didn't call them first. I left them a message but haven't heard back yet.

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I saw in another post that you went to a different doc a week later to get fillers. Do you think that may have affected your results as those deep layers are reforming?
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Skin girl I had a bad experience with fraxel that has left me with scars and issues I didn't have before...I am now looking into fat grafting with extra stem cells and co2 light.....Have you researched this...?? Another girl on this sight has pics posted and she had good results... Ill see if I can find the link??
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Skingirl10, how can you say that the procedure didn't do that much. Looking at your before and after picture, there's a huge difference in terms of the scar. I bearly notice any scar in the pictures you labeled final results. It's a huge improvement. Thank you very much for this detailed documentation of your experience!
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Its worth the shot, like everything else. You would regret it more if you hadn't tried it. At least now you know! My scars are very similar to yours and I find its work in progress. and a part of it is learning to live with them.Thanks again for sharing your experience!
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Dear skingirl: Have patience you will continue to improve over the next months and even over several years as your collagen continues to rebuild. I had co2 laser done 10 years ago and I have seen vast improvements over time. However, the technology has changed and improved so much that I believe that I would now see even more improvements if I have some treatments. I understand the frustration of living with imperfect skin. I too would like to have perfect skin. I am in my 50's and tired of the struggle of imperfect skin also. However, where I see scars my loved ones don't see them anymore. People think I am younger than I am and my mother always told me it was better to have a thicker oilier skin than someone who is pale and will wrinkle easier as they get older. I wish I had before and after pictures so I could appreciate the improvement of my own skin over the past 10 years. So even though you may not be completely satisfied now, give it time. You certainly look beautiful with makeup on so just keep it up and play up your assets!
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Have you gone back to the clinic for an explanation? Didn't they say permanent results? If I remember correctly there was another person who was 4 months out and had his rolling scars come back. However, he was able to somehow get another treatment free of charge, and I would think that for such temporary results he had every right to get a freebie. I would definitely go back to your clinic, if you haven't yet, and demand either another treatment free of charge or other services. There's no way they should get away w/making such lofty claims and be proven completely WRONG by their patients. I truly hope you soon find a permanent solution, good luck :)
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Sorry for all the hassle your going through thanks for doing this for us!
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Would love to see pics from November. How come you did not choose fraxel repair as opposed to active/deep FX?
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Hello Skingirl10, Its not showing any new updated pics. Just the ones 3 weeks post DEEP FX. Just wanted to let you know!
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I wrote my comment above, posted November 23. I also added new pics for everyone to see.
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Hi, is what I consider the final results of my treatment of Deep FX which was done in July. It is now late November. There is good and bad. I am also posting pics without makeup in the worst lighting I could photograph myself in, and set the contrast on high in photoshop so that you could really see any scars or shadows on my face that are there. In other pics, in even indoor lighting that is far more flattering AND with makeup on, you really can't see too much scarring, but it was that way before Deep FX as well. The rolling scars have RETURNED significantly, I'm afraid (sigh). I would say ultimately I received about a 30% improvement in the cheek and forehead area. The lines under my eyes are still gone about 95% but I never had any major ones there to begin with so it was easy for them to disappear. I think Deep FX in COMBINATION with other treatments such as Juvaderm filler may be helpful, as Deep FX simply softens the shadows a little so that when a filler is injected it really smooths out a rolling scar. The pore icepick scars I had prior to Deep FX show no improvement at all. Would I do it again? Not sure. It was very expensive at $3000 and the healing was extremely radical the way it was when I had C02 laser resurfacing twice about 10 years ago. And again, I do NOT recommend doing this if you have small children in the house who will see you post treatment. I have since had a baby and would not let him see me bloody and oozy for the first 4 days of healing for fear of traumatizing him.
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UPDATE please...I am so looking forward to how you have come along after all these months! Your story is a glimmer of hope for many people! :)
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